Objective Chronic graft dysfunction (CGD) has become the major factor that influences the long-term survival of grafts. It is unclear whether the different incidence of CGD has organ specificity. Methods We collected the graft survival rates (GSRs) of solid organ transplantations from the OPTN/SRTR (organ procurement and transplantation network/ scientific registry of transplant recipient). The solid organ transplantations were classified according to the cluster analyses of GSRs during two time periods. We defined the standard of lower survival rate and compared it to the 3-month GSRs (3mGSRs), 1-year GSRs (1y GSRs), 3y GSRs, and 5y GSRs of various solid organ transplantations. Results Deceased donor ECD kidney (DD-ECDK), pancreas transplantation alone (PTA), pancreas after kidney transplantation (PAK), Intestine (In), deceased donor lung (DD-Lu), and heart-lung (H-Lu) were classified into a category which was associated with lower graft survival rates based on the variables of GSRs during the time periods of 1991-1995 and 1996-2000. Compared with those of DD-ECDK, the lowest in the three types of kidney transplantation, the GSRs during the two time periods of the above organ transplantations of lower graft survival were lower [3mGSRs: OR 0.26-0.92, 95%CI (0.20, 0.35)-(0.61,1.39); 1y GSRs : OR 0.30-0.87, 95%CI (0.23,0.37)-(0.78,0.97); 3y GSRs: OR 0.39-0.77, 95%CI (0.30,0.51)-(0.61,0.98); 5y GSRs: OR 0.12-0.87, 95%CI (0.09,0.71)- (0.75,1.0)]. Conclusion The CGD had organ specificity. The grafts of DD-ECDK, PTA, PAK, In, DD-Lu, and H-Lu were identified as the organs with earlier onsets and higher incidence of CGD.
ObjectiveTo systematically evaluate the efficacy and safety of direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKA) in solid organ transplant (SOT) recipients. MethodsThe PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang Data, CBM and VIP databases were electronically searched to collect clinical studies on DOACs (rivaroxaban, apixaban, idoxaban, dabigatran) compared with VKA in SOT recipients from inception to May 15, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 11 cohort studies involving 1 236 SOT recipients were included. The meta-analysis results showed that compared with VKA, DOACs could reduce the risk of any bleeding (RR=0.47, 95%CI 0.37 to 0.60, P<0.05) and major bleeding (RR=0.56, 95%CI 0.37 to 0.84, P<0.05) in SOT recipients. But there were no statistically significant differences in the total incidence of thrombotic events, VTE incidence, and stroke incidence between the two groups. ConclusionCurrent evidence shows that DOACs are not inferior to VKA in anticoagulation therapy for SOT recipients, but they perform better in terms of any bleeding and major bleeding. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.